A Tablet-Based Aphasia Assessment System "STELA": Feasibility and Validation Study.

BACKGROUND: There is an extensive library of language tests, each with excellent psychometric properties; however, many of the tests available take considerable administration time, possibly bearing psychological strain on patients. The Short and Tailored Evaluation of Language Ability (STELA) is a simplified, tablet-based language ability assessment system developed to address this issue, with a reduced number of items and automated testing process. OBJECTIVE: The aim of this paper is to assess the administration time, internal consistency, and validity of the STELA. METHODS: The STELA consists of a tablet app, a microphone, and an input keypad for clinician's use. The system is designed to assess language ability with 52 questions grouped into 2 comprehension modalities (auditory comprehension and reading comprehension) and 3 expression modalities (naming and sentence formation, repetition, and reading aloud). Performance in each modality was scored as the correct answer rate (0-100), and overall performance expressed as the sum of modality scores (out of 500 points). RESULTS: The time taken to complete the STELA was significantly less than the time for the WAB (mean 16.2, SD 9.4 vs mean 149.3, SD 64.1 minutes; P<.001). The STELA's total score was strongly correlated with the WAB Aphasia Quotient (r=0.93, P<.001), supporting the former's concurrent validity concerning the WAB, which is a gold-standard aphasia assessment. Strong correlations were also observed at the subscale level; STELA auditory comprehension versus WAB auditory comprehension (r=0.75, P<.001), STELA repetition versus WAB repetition (r=0.96, P<.001), STELA naming and sentence formation versus WAB naming and word finding (r=0.81, P<.001), and the sum of STELA reading comprehension or reading aloud versus WAB reading (r=0.82, P<.001). Cronbach α obtained for each modality was .862 for auditory comprehension, .872 for reading comprehension, .902 for naming and sentence formation, .787 for repetition, and .892 for reading aloud. Global Cronbach α was .961. The average of the values of item-total correlation to each subscale was 0.61 (SD 0.17). CONCLUSIONS: Our study confirmed significant time reduction in the assessment of language ability and provided evidence for good internal consistency and validity of the STELA tablet-based aphasia assessment system.

Relations between quantitative ultrasound assessment of calcaneus and grip and key pinch power in Japanese mountain village residents.

PURPOSE: It seems to be important to recognize bone health condition using a simple method in Japanese super-aged society. The aim of our study was to investigate whether grip and key pinch strength were associated with bone quality. METHODS: Medical examinations were conducted of 337 adult residents (123 men, 214 women; average age of 64.7 years) of a mountain village. Bilateral grip and key pinch strength were measured. The sound of speed (SOS) of calcaneus was assessed using an ultrasound bone densitometer. Study participants were divided into non-osteoporotic and osteoporotic groups according to the relevant WHO classification to evaluate statistical significance by age-adjusted analysis. Stepwise linear regression was used to identify the predictor of SOS using the following factors as explanatory variables: age, height, weight BMI, grip and key pinch power strength in bilateral side. A P value of < .05 was regarded as statistically significant. RESULTS: In age-adjusted analysis, significant associations were found between osteoporosis and BMI (OR 0.87, 95%CI 0.80-0.95), gender (OR 3.21, 95%CI 1.83-5.62), grip strength (right side:, OR 0.95, 95%CI 0.92-0.98; left side: OR 0.95, 95% CI 0.92-0.98) and key pinch strength (right side: OR 0.76, 95%CI 0.65-0.88; left side: OR 0.79, 95%CI 0.68-0.91). In stepwise linear regression, age and left key pinch strength were predictors of calcaneal SOS (age ß coefficient = -0.46, P = .00; left key pinch strength ß coefficient = 0.17, P = .0049). CONCLUSIONS: Key pinch strength assessment might be useful to predict calcaneal SOS in general population.

Longitudinal nutritional assessment in acute lymphoblastic leukemia during treatment.

BACKGROUND: A nutritional assessment of pediatric patients with cancer is important to improve their outcome. The number of longitudinal nutritional studies during treatment, however, is limited. The purpose of this study was to investigate the longitudinal changes in anthropometric measures and serum albumin level during chemotherapy in patients with acute lymphoblastic leukemia (ALL). METHODS: We retrospectively reviewed the charts of 23 patients (19 boys, four girls) with ALL from April 2007 to March 2010. The median age at diagnosis was 4.5 years. Bodyweight, height, and serum albumin levels were measured at the start and the end point of each chemotherapy phase. RESULTS: At diagnosis, two patients (8.7%) were underweight and five patients (21.7%) were overweight according to body mass index z-score, while five patients were underweight and three (13.0%) were overweight according to Waterlow score. The prevalence of malnourished patients did not change significantly throughout chemotherapy by either assessment. The absolute scores in either assessment were significantly reduced at the sanctuary treatment phase. Low serum albumin (<3.2 g/dL) was found in two patients at diagnosis. Mean albumin decreased significantly at the induction and the re-induction phases. CONCLUSIONS: Given that nutritional status under a similar chemotherapeutic regimen as assessed by anthropometric measures and albumin level differed among patients, careful observation of the nutritional status and intervention may be necessary at different phases of chemotherapy.

Factors associated with exclusive breastfeeding in low birth weight infants at NICU discharge and the start of complementary feeding.

The aim of the present study was to clarify clinical factors in low birth weight infants and their mothers associated with exclusive breastfeeding at both neonatal intensive care unit (NICU) discharge and the start of complementary feeding. One hundred and fifteen low birth weight children and 98 mothers attending the follow-up clinic of two tertiary NICUs in Nara prefecture (Japan), between June and September, 2011, were enrolled. The relationship between the feeding categories at NICU discharge or the start of complementary feeding, and clinical factors of the mothers and low birth weight infants collected by either their charts or a face-to-face interview was analyzed. The prevalence of exclusive breastfeeding was 22.6% at NICU discharge, and 15.7% at the start of complementary feeding. In logistic analysis, exclusive breastfeeding at NICU discharge was associated with mother's younger age at delivery and an earlier start of oral nutrition. Among 26 exclusively breast-fed infants at NICU discharge, fifteen infants (57.7%) were still being exclusively breast-fed at the start of complementary feeding. In low birth weight infants, a shorter stay at NICU and an earlier start of oral nutrition were associated factors with exclusive breastfeeding at the start of complementary feeding. None of maternal factors were found to be associated with exclusive breastfeeding at the start of complementary feeding. Conclusively, starting of oral nutrition as early as possible is thought to be crucial for introducing exclusive breastfeeding in low birth weight infants both at NICU discharge and the start of complementary feeding.